EP2421582B1 - External functional device and system - Google Patents

Description

The present invention relates to an external functional device according to claim 1. It further relates to a system according to the preamble of claim 18.

The cleaning of the equipment used in blood treatments can be technically complicated. In order to ensure adequate hygiene with acceptable workload and for other reasons, external functional devices, such as blood cassettes are used. DE 102 24 750 A1 discloses, for example, a medical fluid treatment device having a cartridge insertable therein.

Such a blood cassette may be designed to perform as many functions as possible in the preparation and execution of blood treatment procedures.

The object of the present invention is to provide a further external functional device designed as a blood treatment cassette. Furthermore, a system consisting of a blood treatment device, which has such an external functional device or is designed to control or actuate it, is proposed.

The object according to the invention is achieved by an external functional device having the features of claim 1.

The external functional device comprises at least one housing body, at least one integrated into the housing body chamber for receiving medical fluids, at least one integrated into the housing body channel for receiving and / or guiding a medical fluid and at least one in the housing body completely or partially integrated valve device for controlling or regulating a fluid flowing through the external functional device.

As used herein, the term "housing body" refers to a three-dimensionally shaped body formed from a material suitable for use in a medical treatment process, such as a blood treatment process, such as a plastic material. The housing body can be produced for example by means of a casting or injection molding process.

The term "chamber" as used herein refers to a volume suitable for receiving at least one medical fluid. The volume may be a closed space or circumscribed by it. But it may also be an open space or be surrounded by such a partial, and only by the presence of another body - other than the housing body - to a closed or closed up to supply or discharge lines for the fluid space.

Chambers may be designed and provided to receive valves and / or sensors or the like.

As used herein, the term "conduit" or "conduit" refers to equipment suitable for receiving and / or delivering medical fluids, such as blood, heparin or other drugs, saline, substituate, and the like.

Channels or lines may be configured in sections as closed and / or semi-open structures. They can be closed, for example, by means of a cover device on at least one open side and thus designed to be sealable against, for example, components of a blood treatment device and / or against the atmosphere.

The term "valve means" as used herein refers to a means suitable for controlling or regulating which can control the passage of fluids through conduits and / or chambers of the external functional device. Valve devices can be controlled by means provided for control or regulating devices. An activation can for example be automated. Suitable control or regulating devices may for example be provided in or on the blood treatment device.

Advantageous developments of the external functional device according to the invention are each the subject of the dependent claims.

According to the invention, a functional device can be understood to mean a device by means of which functions such as the routing of fluid by means of lines, valves, interception of clots and / or the like is possible.

An external functional device can be understood to mean a device which is not a permanent component of a treatment device. An external functional device is rather externally connected to the treatment device for the purpose of treatment.

The external functional device is provided on at least one of its surfaces with a cover device which is part of at least one integrated valve device.

The cover device is at least in one section with the housing body non-positively and / or positively and / or materially connected. The cover device can be connected to the housing body, for example, by means of a circumferential weld or other circumferential connection. It is also possible to provide further non-circumferential or punctiform or local welds or connections (eg adhesions or compressions) of the cover device to the housing body.

In further preferred embodiments, the cover device is connected in certain areas on both sides of structures (at least one structure) to the external functional device, in particular to the housing body. On both sides can be understood according to the invention as at least two sides of the respective structure. A bilateral connection can be understood as meaning at least two-fold connection in the region, in particular immediate region, or in the environment, in particular the immediate environment, of the structure.

These structures include i.a. Fluid channels, lines or other elements of the external functional device. These preferably include those elements which are designed to be open in a cross-section perpendicular to the main extension plane of the cover device and / or covered by the cover against an exterior or the atmosphere.

The two-sided connection can be a weld. It may each be fluid-tight, e.g. in such a way that no fluid exchange, in particular no fluid exchange, can take place over the joining region (region in which, for example, was glued or welded) of the compound. The bilateral connection may be for individual fluid channels, conduits or other elements, e.g. in selected areas of the external functional device, be provided; it may be provided for a majority thereof or for all fluid channels, conduits or other elements.

A two-way connection can be a connection both to the left and to the right of the corresponding structure. It may be provided both above and below with respect to the structure or the like.

A bilateral connection may be one, two or more welds along the edge or circumference or the attachment of at least one structure or portion thereof.

A bilateral connection may be elongated or elongated, in whole or in portions thereof.

By means of the two-sided connection, the expenditure required for pressing the external functional device can be advantageously reduced in certain embodiments according to the invention. In particular, in some embodiments according to the invention, the precision requirements with which the contact pressure of the external functional device can be adjusted, e.g. to a blood treatment device, advantageously be lower. In certain embodiments according to the invention can advantageously satisfy a low contact pressure due to the two-sided connection. In some embodiments of the invention, a more reliable function of valves acting on channels covered by the bilateral connection may advantageously be achieved.

A covering device may in particular be a foil.

The film may preferably be a plastic film. For this purpose, preferably any laser-weldable film which appears suitable to the person skilled in the art may be considered.

In another preferred embodiment, the external functional device may have ports for communicating with an extracorporeal circuit in fluid communication.

The external functional device is designed as a cassette to or for a blood treatment.

More preferably, the external functional device by means of two connectors with at least one - preferably two - peristaltic pump (s) in fluid communication can be connected. Roller pumps may be suitable peristaltic pumps.

The external functional device can have at least one - preferably two - pumping tube segment (s) or can be configured or provided for receiving such.

In a further preferred embodiment, the external functional device has at least one valve device which has at least one web and a section of the cover device. The web is designed on the housing body. The bridge and covering device are arranged to be actuatable by means of an actuator of a blood treatment device acting on a web for changing a fluid flow in the sense of a valve.

Such a "web" may designate a component integrated into the external functional device or projecting from a surface thereof in any direction. This can be formed from the same material as the external functional device. A web can be configured, for example, during the production of the external functional device by means of casting or injection molding.

In a further preferred embodiment, the fluid which flows through the external functional device in its use is a substituate, heparin or another pharmacologically active substance, saline (in particular 0.9% NaCl solution), blood, air and combinations thereof.

The external functional device can in particular be coupled to a blood treatment device. Further preferably, it can be designed and provided to be connectable to the blood treatment device by means of a receiving device of the blood treatment device. The external functional device can in particular be coupled to the treatment device with the surface facing the covering device.

In a further preferred embodiment, the external functional device can be moved backwards at an angle of inclination, preferably between 5 ° and 11 °, in particular in FIG an inclination angle of substantially or exactly 8 °, with respect to a vertical to be coupled to the blood treatment device. The external functional device is preferably inclined backward in an upper area thereof (in the use state).

In a further preferred embodiment, the external functional device has at least one substituate addition point, which has a contact protection element and / or a drip protection. Other sections, in particular any other section, of the external functional device may also have a contact protection element and / or a drip protection.

A closure function of the ports (one, some or all ports) of the external functional device can also be realized by septa or check valves.

The drip protection can be realized for example by an integrated closure sleeve.

The drip guard may preferably be used to prevent dripping or running out of substituate or blood or a mixture of substituate and blood during the removal of the external functional device from the receiving device of the blood treatment device. In this way, a hygienic handling of the used and impure external functional device can also be guaranteed outside the treatment device.

The external functional device according to the present invention may be suitable for use in a blood treatment method using double-needle access or single-needle access.

The patient's blood is preferably passed out of the patient through the dialyzer during the withdrawal phase, thereby dialyzed (preferably directly) after passing through the dialyzer in the single-needle chamber and returned to the patient from there in the return phase. The blood is in the "fresh" State dialysed, in which it comes from the patient. Thus, the performed by means of the cartridge for blood treatment according to the invention method may advantageously differ from those conventional methods in which the patient taken blood, stored in a separate single-needle chamber, then dialyzed and returned to the patient via a venous air separator ,

The external functional device may preferably have at least one single-needle chamber in which a blood surge redirecting element is arranged.

Such a "blood surge diverter" or blood surge element may be suitable and provided for achieving flow deceleration, generating turbulence and / or diverting the blood flowing into the single-needle chamber, or canceling the pulse of the blood surge. Such Blutschwallumleitungselement can be designed in particular flow optimized. It may be configured, for example, in the form of an ellipsoidal or round column, which is connected at at least a portion of its circumference to a wall of the single-needle chamber.

Without Blutschwallumleitungselement a flow of blood flowing through the phantom could possibly cause a fountain. This could lead to sloshing of the liquid level and / or foaming. By means of the Blutschwallements the total blood surge is divided into two smaller blood swells, whereby the pulse of the total bloodstream can be extinguished and beneficial fountain formation, sloshing movement and / or foaming can be avoided.

As Blutschwallumleitungselement a Blutschwallumleitungselement can preferably be used, as in the by the applicant of the present invention in the patent application 10 2009 024 466.2 entitled "Receiving device for receiving medical fluids and external functional device and medical treatment device " filed on 10 June 2009 with the German Patent and Trademark Office.

The external functional device of the present invention has at least one venous blood chamber.

The single-needle chamber is located above, based on the orientation of the external functional device during its use, the venous blood chamber.

The external functional device of the present invention has a single-needle blood valve disposed between the venous blood chamber and the single-needle chamber.

The venous blood chamber can be divided into at least one upper space and at least one lower space by means of a cross-sectional narrowing of the housing body.

The upper space and the lower space may be in fluid communication with each other.

The upper space may be configured to allow or generate a tangential inflow of fluids flowing through the external functional device. The upper space may have a region for generating a stable rotational flow of the fluids flowing through the external functional device.

The lower space may have a region that is substantially or completely free of rotational flow of the fluids flowing through the external functional device.

Preferably, walls or wall portions of the upper space and / or the lower space of the venous blood chamber may be adapted to a slope of the external functional device against a vertical of the blood treatment device. This may advantageously allow for flow-optimized flow or flow of the blood through the venous blood chamber and the rise of air possibly in the blood for the purpose of separation.

The venous blood chamber may be configured and, in particular, have an air-separating action, as in that of the Applicant of the present invention in the patent application 10 2009 024 465.4 entitled "Air separator, external Functional device, blood circulation and treatment device " filed on 10 June 2009 with the German Patent and Trademark Office (DPMA).

In a further preferred embodiment of the external functional device, the housing body is designed as a hard part.

The hard part may be a housing body made substantially of one piece and a material. This can be an injection molded part. It may have a minimum stiffness of more than 400 N / mm ² , preferably 1200-1800 N / mm ² (bending modulus).

In a further preferred embodiment of the external functional device as a blood treatment cassette, in a further preferred embodiment, the pressure in the extracorporeal blood circulation upstream of the dialyzer can be measured through the covering device or foil.

The external functional device may preferably be a disposable article which is disposed of after a single use.

The object according to the invention is also achieved by a system according to claim 18.

The blood treatment device of the system comprises at least one external functional device according to the present invention.

The blood treatment device of the system has at least one control device and / or actuators and / or sensors for activating and / or actuating the external functional device.

The controller may be configured as a CPU or part thereof.

The control device and / or the actuators can be suitable and provided for example for operating or controlling, ie, for example, controlling or regulating a valve device. They may be arranged at a position of the blood treatment device, which is opposite to a valve device of the external functional device in its coupled state.

The blood treatment device of the system has at least one receiving device for receiving at least one external functional device according to the present invention. In this case, the receiving device has a coupling surface for coupling the external functional device according to the present invention. Such a coupling surface may, for example, be inclined at an angle to a vertical relative to the orientation of the blood treatment device during its use, in particular to the rear. Such an angle can be between 5 and 11 °, in particular substantially or exactly 8 °.

The blood treatment device may be suitable for carrying out a method or a method step as described below and with reference to the figures.

In a further embodiment, the blood treatment device has a control - e.g. in the form of a CPU - for controlling or regulating an external functional device according to the present invention and / or for performing a method or a method step, as described below and with reference to the figures.

Furthermore, the blood treatment device may comprise at least one actuator for actuating an external functional device according to the present invention or a portion thereof for carrying out a method or a method step described herein.

In particular, the blood treatment device may also have sensors as information sources, the information of the control unit serving as signals for actuating an external functional device according to the present invention for carrying out a method or a method step described herein.

The blood treatment device may be, for example, a dialysis device.

The blood treatment device may include a controller for measuring a parameter present in the extracorporeal circuit or blood circulation of the external functional device according to the invention designed as a blood treatment cassette, for example a pressure, a differential pressure and the like.

The differential pressure can be measured between the arterial cassette integrated chamber and the venous cassette integrated chamber. The differential pressure can be used as a measure of the blood-side pressure difference of the dialyzer. The controller of the blood treatment device may be configured to calculate this difference, if necessary to compare the pressure difference with reference values (which may be stored for example in the controller or a memory), and optionally for outputting control signals.

In this case, for example, an incipient blockage of the dialyzer can advantageously be detected early or in good time. Countermeasures can be taken.

These may include the addition of anticoagulants, e.g. Heparin, e.g. include or consist of the cartridge integrated inlets.

Furthermore, for example, the predilution can be increased. It can be switched from postdilution to predilution.

The cassette-integrated measuring points can also advantageously allow transmembrane pressure measurement across the dialyzer membrane.

For this purpose, four measuring points can be present, at which by means of appropriate devices is measured and the measurement results are evaluated by means of suitable devices: one at the filter inlet and at the filter outlet, both on the blood side and dialysate side.

In some embodiments according to the invention, the external functional device in certain sections thereof is (at least) designed to be thicker or thicker than other sections in a direction perpendicular to the coupling plane (or to a main section thereof). The stronger or thicker portions, of which there may be one or more, serve to receive measuring devices, such as e.g. optical measuring devices, ultrasonic devices, temperature measuring devices, and the like.

The same benefits may have portions of the external functional device, which are not designed stronger or thicker, but which extend mainly in the Hauptersteckungsebene the external functional device, preferably parallel to a main coupling plane of the external functional device and / or parallel to an actuator-sensor plate treatment device. These extending the external functional means sections (one or more), at the same time be made stronger or thicker; However, this is not required according to the invention.

The measuring devices can be or are connected to the treatment device starting from one side of the door of the treatment device with which the external functional device is compressed and / or covered for use with the treatment device in certain embodiments according to the invention.

The measuring devices can be or be connected to the treatment device starting from one side of an actuator-sensor plate of the treatment device, by means of which in some embodiments according to the invention a functional or signal connection between external functional device and treatment device is achieved.

Measuring devices arranged in such thicker or longer or longer configured sections may be used, for example, for measuring states within in or outgoing fluid channels of the external functional device (in particular those fluid channels which remove or supply fluid from the external functional device). They can be arranged in the immediate vicinity of such fluid channels.

All or some of the thicker or thicker or longer designed sections are preferably in an edge region of the external functional device. This can advantageously allow a simple connection between the measuring device, which lies in each case in one of the aforementioned sections, and the treatment device. Furthermore, this arrangement in an edge region allow easy accessibility.

The external functional device may in the above-mentioned thicker or thicker or longer designed sections or elsewhere measuring points for coupling detectors such. having optical detectors for detecting line or valve leakage. Such leaks may e.g. in the area of the phantom valves, the check valves, the supply or discharge lines (for example to or from the valves) or the like. The measuring points and / or the, in particular optical, detectors can be arranged at the appropriate place.

In some embodiments according to the invention, the external functional device may have one or more addition points, which each have at least one septum. The septum may be provided at the time of addition easy to be penetrated, but it still advantageously closure and thus provides security and tightness.

The addition points are preferably integrated in the external functional device or produced integrally therewith.

The addition points may be arranged in an end region or edge region of the external functional device. This arrangement may advantageously allow easier access to the addition points in some embodiments of the invention. In certain embodiments of the invention, this is especially true in the event that the external functional device is in contact with (eg, compressed by) both its front and rear surfaces for coupling to a treatment device and thus front and rear for addition via the septum difficult or laborious to reach. It may thus result in some embodiments ergonomic Voreile.

In further preferred embodiments, supply lines may be arranged on or in the external functional device such that the supply line (wholly or partly) or a connection point (such as a connection port of the supply line) to the supply line are in an upper region of the external functional device - preferably with respect to a proper position or arrangement of the external functional device during its intended use (eg in a compressed state with the treatment device).

The upper area can be a border area. The upper region may be an area above a coupling surface or a coupling region.

The supply line may be a conduit for an anticoagulant. It can be a heparin line. An associated syringe pump for the anticoagulant, eg Heparin, can be arranged in the use of the external functional device above the external functional device or the coupling plane.

Advantages to be achieved in some embodiments of the invention include ergonomic advantages, advantages associated with shorter supply line, better accessibility of the joint, and more.

In some embodiments, supply lines can be understood as conduits via which fluids can be supplied to the extracorporeally flowing blood during the use of the external functional device during blood treatment or which are provided for this purpose.

The blood treatment device may include a controller for driving the cassette valves. The controller may preferably freely programmably switch between the cartridge integrated pre and post dilution. It can preferably change the substituate flow (volume flow). Information providers may be, in particular, the cassette-integrated pressure measuring points arranged before and after the dialyzer.

The procedures are explained below.

The blood treatment method is hereinafter exemplified as a dialysis method, such as hemodiafiltration. The blood treatment device is, for example, a dialysis device.
The dialyzer has an extracorporeal circuit with an arterial and a venous section. The dialyzer also has an arterial and a venous patient tube clamp.

During dialysis, a patient is connected to the extracorporeal circuit via a patient access, such as a fistula, a shunt or a catheter, for example in the form of a double-needle access or single-needle access.

The extracorporeal circuit may include a blood pump for delivering blood and a substituate pump for delivering substituate and corresponding pump tubing segments.

The blood pump and the substituate pump can be designed as peristaltic pumps, for example as roller pumps.

A "conveying direction" or "flow direction" of the blood during a dialysis treatment refers to a direction in which the blood to be purified is usually conveyed. In particular, it may designate a direction that extends from the patient via an arterial needle, an arterial section, a dialyzer (bottom to top in the figures), a venous section, and a venous needle back to the patient.

A fluid delivery (in particular of blood and / or of substituate) taking place against this conveying direction is referred to as conveying or flow in the opposite direction.

The blood treatment device has a dialysis device with a dialysis fluid inlet and a dialysis fluid outlet, wherein the dialysis fluid can be conveyed through the dialysis device in the opposite direction to the blood (from top to bottom in the figures).

A substituate may be introduced through a substituate addition site and introduced into the extracorporeal circuit through a pre-dilution addition valve and / or a post-dilution addition valve.

The terms "clockwise" or "counterclockwise" refer to the figures. A blood pump and a substituate pump will usually deliver counterclockwise, as may be the usual delivery direction during a dialysis treatment.

When priming or filling , the pre-dilution addition valve, the post-dilution addition valve, and a single-needle blood valve may initially be open, respectively.

Preferably, the arterial patient tube clamp and the venous patient tube clamp are also open.

The arterial patient port and the venous patient port are preferably interconnected.

A tap, which is a machine-side valve (also known as "rinse port"), via which a fluid connection between the extracorporeal circuit and the atmosphere or a collecting container can be produced and over which the external functional device by flowing fluids can be discharged from the extracorporeal circuit, is preferably also closed.

Substituate is added via the substituate addition site.

The substituate pump is started, it is preferably operated counterclockwise (based on the drawing plane of the attached figures). The blood pump is started, preferably in a clockwise direction.

Substituate is preferably delivered to or before the post-dilution addition valve. The post-dilution addition valve is preferably closed upon reaching.

Substituate is conveyed through the pre-dilution addition valve, preferably towards the dialyzer and / or towards the blood pump.

In this case, the substituate flowing in the direction of the dialysis device can flow through the dialysis device and the venous section of the extracorporeal circuit and enter a venous blood chamber of the external functional device.

The substituate flowing toward the blood pump may flow clockwise through the pump tubing segment inserted into the blood pump. Preferably, the substituate also flows through the connection between arterial and venous patient port, flows through a clot trap of the external functional device and enters the venous blood chamber.

On or in the clot trap, the pressure in the extracorporeal circuit can be measured by means of a suitable pressure measuring device. This may preferably be achieved by a covering device of the external functional device, e.g. designed as a blood treatment cassette done. If this is configured as a film, the measurement can be carried out through it or over the film. In this way, it is thus possible to measure the pressure in the extracorporeal circulation, in particular after passing through the dialyzer.

In this case, it is possible for the substituate, which flows in the direction of the dialysis device, to be mixed with that substituate which flows in the direction of the blood pump in the venous blood chamber.

If the venous blood chamber is filled, preferably the pre-dilution addition valve 51 and the single-needle blood valve may be closed or automatically closed.

The substituate pump preferably stops or stops. The pre-dilution addition valve, the post-dilution addition valve, and the single-needle blood valve are preferably closed.

By operating the blood pump Substituate is promoted by the extracorporeal circulation. In the single-needle chamber, preferably no substituate or only a small amount of substituate is present.

1. 1. Konnektion des automatischen Substituat-Konnektors.
2. 2. Arterieller und venöser Patientenschlauch werden mit einem Rinse-Port der Blutbehandlungsvorrichtung verbunden, z. B. mittels eines geeigneten Verbinders, mit dem für das Ende des einen Patientenschlauchs ein Zugang in den anderen Patientenschlauch geschaffen wird. Das Ende des anderen Patientenschlauchs dient als Ablaufleitung in den Rinse-Port. Der Verbinder kann sich alternativ in der arteriellen oder der venösen Patientenleitung befinden.
3. 3. Die venöse Patientenschlauchklemme wird geschlossen, das Postdilutionsventil wird geöffnet, das Prädilutionsventil wird geschlossen.
4. 4. Füllen der venösen Kammer mittels der Substituatpumpe durch das Postdilutionsventil. Dabei erfolgt eine Luftabscheidung durch das Single-Needle-Ventil.
5. 5. Die Blutpumpe läuft vorwärts und saugt aus der venösen Kammer Substituat an.
6. 6. Sinkt der Pegel in der venösen Kammer, so wird über das Postdilutionsventil nachgefördert, bis ein Überschreiten der vorgegebenen Füllhöhe vom Level-Detektor erkannt wird. Während dieses sich bei Bedarf wiederholenden Vorgangs läuft die Blutpumpe kontinuierlich weiter.
7. 7. Entlüften des Gerinnselfängers " von unten": Alle drei Kassettenventile sind geschlossen. Die arterielle Klemme ist geöffnet und die venöse Klemme ist geschlossen. Der Rinse-Port ist geschlossen.
8. 8. Die Blutpumpe läuft kurz rückwärts und fördert ein kleines Volumen. Dadurch wird venös ein Unterdruck und arteriell ein Überdruck im extrakorporalen Blutkreislauf erzeugt.
9. 9. Öffnen der venösen Klemme solange, bis ein Druckausgleich stattgefunden hat.
10. 10. Fortsetzen des Füllens des extrakorporalen Blutkreislaufs.
11. 11. Spülen des gefüllten extrakorporalen Blutkreislaufs: Mittels des venösen Luftblasendetektors wird das Auftreten von Luftblasen detektiert. Sobald im Verlauf eines vorgegebenen Zeitintervalls keine Luftblasen oder nahezu keine Luftblasen detektiert wurden, gilt der extrakorporale Blutkreislauf als gefüllt.
12. 12. Während des Spülens wird Substituat durch das Prädilutionsventil gefördert und durch den Rinse-Port ("Hahn") verworfen.
13. 13. Dabei sind sowohl die arterielle als auch die venöse Klemme geöffnet. Die Blutpumpe läuft rückwärts und fördert einen Teil des Substituats in den Rinse-Port.

The online filling procedure can also run as follows:

1. 1. Connection of the automatic substituate connector.
2. 2. Arterial and venous patient tubing are connected to a rinse port of the blood treatment device, e.g. Example by means of a suitable connector, with the access to the other patient tube is created for the end of a patient's hose. The end of the other patient tube serves as drainage into the rinse port. The connector may alternatively be in the arterial or venous patient line.
3. 3. The venous patient tube clamp is closed, the post-dilution valve is opened, the pre-dilution valve is closed.
4. 4. Fill the venous chamber by means of the substituate pump through the post-dilution valve. In this case, an air separation takes place through the single-needle valve.
5. 5. The blood pump advances and sucks substituate from the venous chamber.
6. 6. If the level drops in the venous chamber, the postdilution valve is subsequently fed on until the level of the predetermined level is exceeded by the level detector. During this repetitive process, the blood pump continues to run.
7. 7. Bleeding the clot catcher "from below": All three cassette valves are closed. The arterial clamp is open and the venous clamp is closed. The rinse port is closed.
8. 8. The blood pump runs backwards for a short time and promotes a small volume. As a result, a negative pressure and arterial pressure in the extracorporeal blood circulation is produced venously.
9. 9. Open the venous clamp until a pressure equalization has taken place.
10. 10. Continue filling the extracorporeal blood circulation.
11. 11. Rinsing the filled extracorporeal blood circulation: The venous air bubble detector detects the occurrence of air bubbles. As soon as no air bubbles or almost no air bubbles have been detected in the course of a given time interval, the extracorporeal blood circulation is considered filled.
12. 12. During rinsing, substituate is delivered through the pre-dilution valve and discarded through the rinse port ("cock").
13. 13. Both the arterial and venous clamps are open. The blood pump runs backwards and conveys some of the substituate into the rinse port.

As an alternative to online filling (the substituate is provided online in the dialysis machine), filling with an external bag containing saline solution as the source of the filling liquid is also possible. For this purpose, the arterial patient line is connected to the saline bag. The venous patient line is connected to a so-called waste bag as sink for the used saline solution. The blood pump is running forward. By opening the pre-dilution valve and the post-dilution valve, the line between these two valves can also be filled.

In both methods, the patient is connected to the extracorporeal blood circuit only after reaching a predetermined flushing volume.

When rinsing or rinsing , preferably both the pre-dilution addition valve, the post-dilution addition valve and the single-needle blood valve are closed.

The arterial patient tube clamp and the venous patient tube clamp are preferably open at the beginning.

The arterial patient port and the venous patient port are still connected.

Substituate is promoted by operating the blood pump through the extracorporeal circuit with, for example, no substituate in the single-needle chamber.

The pre-dilution addition valve is now preferably opened, as well as the cock (a machine-side valve or a "rinse port").

By operating the substituate pump (preferably counterclockwise of the drawing plane) and the blood pump (preferably clockwise), substituate is preferably continuously delivered through the extracorporeal circuit. The blood pump can rotate slower than the substituate pump.

The substituate can escape via a drain line from the extracorporeal circuit and discarded.

To perform a dialysis, a patient is connected to the extracorporeal circuit. The connection can be made for example by means of a double-needle access or with the help of a single-needle access.
In a first variant of a patient connection , the pre-dilution addition valve, the post-dilution addition valve and the single-needle blood valve may preferably be closed.

A patient can be connected to the extracorporeal circuit via a double needle access via an arterial needle and a venous needle.

The arterial patient tube clamp and the venous patient tube clamp may initially preferably be closed.

Then the arterial patient tube clamp can be opened.

The blood pump may be operated (preferably counterclockwise) and may preferentially deliver blood through the arterial needle into the extracorporeal circuit.

Substituate can be discharged from the extracorporeal circulation at Dialysierflüssigkeitsaustritt and discarded.

When the blood to be purified arrives at a blood inlet on the dialyzer, the arterial patient tube clamp can preferably be closed and the venous patient tube clamp can then be opened.

The blood pump can be stopped.

Now, blood may preferably flow through the venous needle into the extracorporeal circuit and through the clot trap into the venous blood chamber and through a venous filter line to a blood outlet from the dialyzer.

Alternatively, a patient can be connected via a patient connection according to a second variant with the extracorporeal circuit.

First, the pre-dilution addition valve, the post-dilution addition valve, and the single-needle blood valve will preferably be closed.

For example, the patient may again be connected to the extracorporeal circuit via a double needle access via an arterial needle and a venous needle.

The blood pump can now be operated (preferably counterclockwise) and promote blood through the arterial needle into the extracorporeal circuit. The blood can preferably flow through the dialyzer and the external functional device. The blood may preferably enter the patient via the venous needle.

The arterial and venous patient tube clamps may preferably remain open.

In a dialysis treatment without addition of substituate, the pre-dilution addition valve and the post-dilution addition valve may be closed. When performing a dialysis treatment using a double-needle access, the single-needle blood valve may preferably be closed.

Furthermore, the arterial patient tube clamp and the venous patient tube clamp are preferably open so that blood can flow continuously through the extracorporeal circuit.

Preferably, the blood pump can deliver blood back through the arterial needle into the extracorporeal circuit and through the venous needle to the patient.

The blood flows through the dialysis device, where it can be cleaned in an advantageous manner by means of the dialysis fluid flowing in the opposite direction to the blood through the dialysis device.

Preferably, both steps, namely the arterial suction and the venous suction - at least over a period of time - carried out in parallel.

The term "on-line HDF predilution" denotes a dialysis method, in particular a hemodiafiltration, in which substitution is added to the blood to be purified.

Preferably, in this method ("Online HDF Pre-dilution"), the pre-dilution addition valve may be open, but the post-dilution addition valve and the single-needle blood valve may be closed.

The arterial patient tube clamp and the venous patient tube clamp may preferably be open.

The blood pump (preferably running counterclockwise) may deliver blood back through the arterial needle into the extracorporeal circuit and through the venous needle to the patient or his vascular system, as previously described with respect to a dialysis treatment.

The substituate pump (preferably running counterclockwise) may deliver substituate which may mix with the blood at or from the pre-dilution addition valve in the arterial portion of the extracorporeal bloodstream.

As described above, the dialysis fluid can preferably be passed through the dialysis device in the opposite direction to the blood and used to clean the blood which also flows through the dialysis device.

The term "on-line HDF postdilution" refers to a dialysis method, in particular a hemodiafiltration, in which substitution is added to the purified blood.

Preferably, the post-dilution addition valve may be open, but the pre-dilution addition valve and the single-needle blood valve may be closed.
The process flow is essentially the same as the "Online HDF Pre-dilution" described above except that the substituate on and / or from the post-dilution addition valve in the venous section can be added to and mixed with the purified blood.

A so-called "online HDF mixed dilution" refers to a process in which a process of "online HDF predilution"; as described above and a process of "online HDF post-dilution" as described above can be switched.

Each sub-process of predilution or postdilution can be maintained for a specific interval. Each sub-process can be repeated continuously.

The temporal part of the pre- or postdilution can be fixed or variable and can be changed depending on a measurand.

As an alternative to blood treatment using double-needle access to the patient as described above, the blood treatment may be carried out using a single-needle approach (" Cassette Integrated Single Needle ").

A single-needle approach may have a Y-shaped branching into the arterial section and the venous section of the extracorporeal circuit.

The pre-dilution addition valve and the post-dilution addition valve may be closed. The single-needle blood valve, on the other hand, may preferably be open. In this way, fluid communication between the venous blood chamber and a single-needle chamber may be possible.

The arterial patient tube clamp and the venous patient tube clamp may be closed.

The patient is connected to the extracorporeal circuit and the arterial patient tube clamp can preferably be opened.

The blood pump may preferentially deliver blood through the extracorporeal circuit via the venous blood chamber to the single-needle chamber of the external functional device.

When the single-needle chamber is substantially or completely filled, the blood pump may preferably be stopped and the arterial patient tube clamp closed. Then the venous patient tube clamp can be opened.

The venous section allows blood to flow back into the patient's vasculature or to the patient.

Then the arterial patient tube clamp is preferably opened.

The process may be repeated as often and / or as desired, continuously or at certain intervals.

A combination of single-needle treatment with hemodiafiltration is also possible.

Following a blood treatment procedure, the extracorporeal circulation after the treatment may preferably be returned to the patient.

In a first variant of the blood return , the pre-dilution addition valve may be open and the post-dilution addition valve and the single-needle blood valve closed.

The arterial patient tube clamp may preferably be closed, while the venous patient clamp may be opened.
The arterial needle and the venous needle of a double-needle access may preferably remain on the patient.

The substituate pump (preferably running counterclockwise) may be operated and preferably promotes substituate through the pre-dilution addition valve into the extracorporeal circuit.

The substituate may flow through the dialyzer and the venous portion of the extracorporeal circuit, thereby displacing the blood. Just before the substituate reaches the venous needle, the substituate pump may preferably be stopped.

Then the venous patient tube clamp can be closed and the arterial patient tube clamp opened.

The substituate pump (preferably runs counterclockwise) and the blood pump (preferably running in a clockwise direction) can be operated.

The substituate may be delivered from the pre-dilution addition valve into the arterial section towards the patient. Shortly before reaching the arterial needle, both pumps can preferably be stopped.

The return by the arterial and the venous needle can also be done simultaneously. The substituate pump then advances at a higher rate and the blood pump at a lower rate backwards.

In a second embodiment of the blood recirculation process , the pre-dilution addition valve, the post-dilution addition valve, and the single-needle blood valve may be closed.

The arterial patient tube clamp and the venous patient tube clamp may preferably be closed.

Preferably, at least one sensor / detector may be provided in the arterial part of the extracorporeal blood circulation and at least one sensor / detector may be provided in the venous part of the extracorporeal blood circulation.

The arterial needle can be disconnected from the patient and / or the arterial patient lead can be disconnected from the arterial needle. The arterial patient tube clamp and the venous patient tube clamp are preferably opened.

The blood pump (preferably running counterclockwise) can be operated and promote blood through the arterial needle into the extracorporeal circuit.

Preferably, when the sensor / detector senses the presence of air in the arterial portion of the extracorporeal blood circuit, the blood pump may continue to deliver until blood arrives at the pre-dilution addition valve. Then, the blood pump may preferably be stopped.

The arterial patient connection can be closed.

The substituate pump can be operated (preferably counterclockwise).

The pre-dilution addition valve may be opened and the substituate pump may preferentially deliver substituate through the pre-dilution addition valve into the extracorporeal circuit.

The substituate may flow through the extracorporeal circuit and preferably displace the blood therein. Preferably, when the venous patient tube clamp sensor / detector detects the appearance of substituate, the substituate pump may continue to deliver blood and substituate through the venous needle into the patient until all blood has been returned from the extracorporeal circuit to the patient.

Finally, the venous needle can be pulled and the pumps preferably stopped.

For emptying , the pre-dilution addition valve and post-dilution addition valve may be open, while the single-needle blood valve may be closed.

The arterial patient tube clamp and the venous patient tube clamp may be closed.

The arterial patient port and the venous patient port may preferably be interconnected.

At the beginning of the process, the arterial patient tube clamp and the venous patient tube clamp can be opened.

Substituate may preferably be introduced into the extracorporeal circulation at or via the substituate addition point. For emptying, air can be conveyed.

The substituate pump can be operated (counterclockwise) and promote substituate through the extracorporeal circuit to the pre-dilution addition valve and the post-dilution addition valve.

Used Substituat can leave the extracorporeal circulation preferably on Dialysierflüssigkeitsaustritt and discarded. The air can be pumped and thereby displace the substituate.

The substituate can be promoted on the one hand by the pre-dilution addition valve and on the other hand by the post-dilution addition valve in the direction of dialysis.

The pre-dilution addition valve can be closed. The blood pump can be started.

By operating the blood pump (preferably runs counterclockwise) and the substituate pump (runs preferably counterclockwise), air can through Extracorporeal circulation - beginning upstream of the post-dilution addition valve - are conveyed through the venous blood chamber, the clot trap, the venous section, the arterial section in the direction of the dialysis. It may preferentially leave the extracorporeal circuit through the dialysis fluid outlet. The used substituate can be discarded.

In preferred embodiments of the invention, the external functional device comprises at least one tap, suitable and provided for withdrawing a fluid, which is not blood or not exclusively blood, from the external functional device while the external functional device is connected to a treatment device ,

In preferred embodiments according to the invention, the external functional device has at least one tube fixation for fixing at least one section of at least one tube to the external functional device during its coupling to a treatment device.

In preferred embodiments of the invention, the fluid is part of the group comprising substituate, heparin, blood, saline, air, and combinations thereof.

In preferred embodiments according to the invention, the external functional device can be coupled to the blood treatment apparatus at an angle of inclination, in particular substantially or precisely 8 °, relative to a vertical.

In preferred embodiments of the invention, the external functional device has at least one single-needle chamber in which a blood flow bypass element is arranged.

In preferred embodiments of the invention, walls of the upper space and / or the lower space of the venous blood chamber are adapted to a slope of the external functional device against a vertical of the blood treatment device.

In preferred embodiments according to the invention, walls of the venous blood chamber have at least one indentation.

In preferred embodiments of the invention, the housing body is designed as a hard part.

In preferred embodiments according to the invention, the external functional device has a tamper-evident protection, which is realized by means of the design of the substituate addition point.

In preferred embodiments of the invention, the tamper-evident protection is realized by means of a contact protection element or the closure sleeve of the substituate addition point, based on a change in its position within or relative to the cassette and / or a change in its shape.

In preferred embodiments of the invention, the external functional device has a reuse protection implemented by means of the substituate addition site design.

In this case, in preferred embodiments of the invention, a closure sleeve is made unusable for reuse.

In preferred embodiments of the invention, the docking surface is inclined at an angle to a vertical relative to the orientation of the blood treatment device during its use or the center of the earth. In preferred embodiments of the invention, the angle is against a vertical, relative to the orientation of the blood treatment device during its Use or the center of the earth between 5 and 11 °, in particular substantially or exactly 8 °.

In preferred embodiments of the invention, the blood treatment device has a controller for controlling or regulating an external functional device according to the invention.

In preferred embodiments of the invention, the blood treatment device according to the invention comprises at least one actuator for actuating an external functional device according to the invention or a portion thereof for carrying out a method described herein.

In preferred embodiments of the invention, the blood treatment device has sensors for outputting signals as the basis for actuating an external functional device according to the invention for carrying out a method described herein.

Fig. 1

zeigt eine Seitenansicht einer an ihrer Vorderseite mit einer Abdeckungseinrichtung versehenen erfindungsgemäßen externen Funktionseinrichtung gemäß einer bevorzugten Ausführungsform;

Fig. 2

zeigt die externe Funktionseinrichtung der Fig. 1 mit nach zerstörendem Aufschneiden aufgeklappter Abdeckungseinrichtung;

Fig. 3

zeigt die externe Funktionseinrichtung aus Fig. 1 und Fig. 2 von ihrer Rückseite;

Fig. 4

zeigt schematisch vereinfacht eine Phase während der Durchführung eines Vorbereitungs- oder Priming-Prozesses vor Ausführung eines Blutbehandlungsprozesses;

Fig. 5

zeigt schematisch vereinfacht eine Phase während der Durchführung eines Spülungs- oder Rinsing-Prozesses vor Ausführung eines Blutbehandlungsprozesses;

Fig. 6

zeigt schematisch vereinfacht eine Phase während der Durchführung eines ersten Prozesses zum Anschließen eines Patienten an einen extrakorporalen Kreislauf einer Blutbehandlungsvorrichtung;

Fig. 7

zeigt schematisch vereinfacht eine Phase während der Durchführung eines zweiten Prozesses zum Anschließen bzw. Konnektieren eines Patienten an einen bzw. mit einem extrakorporalen Kreislauf einer Blutbehandlungsvorrichtung;

Fig. 8

zeigt schematisch vereinfacht eine Phase während der Durchführung eines ersten Blutbehandlungsprozesses;

Fig. 9

zeigt schematisch vereinfacht eine Phase während der Durchführung des Blutbehandlungsprozesses aus Fig. 8 unter Einsatz von Prädilution;

Fig. 10

zeigt schematisch vereinfacht eine Phase während der Durchführung des Blutbehandlungsprozesses aus Fig. 8 unter Einsatz von Postdilution;

Fig. 11

zeigt schematisch vereinfacht eine Phase während der Durchführung des Blutbehandlungsprozesses aus Fig. 8 unter Einsatz von Mischdilution (Prädilution);

Fig. 12

zeigt schematisch vereinfacht eine Phase während der Durchführung des Blutbehandlungsprozesses aus Fig. 8 unter Einsatz von Mischdilution (Postdilution);

Fig. 13

zeigt schematisch vereinfacht eine Phase während der Durchführung eines zweiten Blutbehandlungsprozesses unter Verwenden eines Single-Needle-Zugangs;

Fig. 14

zeigt schematisch vereinfacht eine Phase während der Durchführung eines ersten Blutrückführungsprozesses;

Fig. 15

zeigt schematisch vereinfacht eine Phase während der Durchführung eines zweiten Blutrückführungsprozesses;

Fig. 16

zeigt schematisch vereinfacht eine Phase während der Durchführung eines Entleerungs- oder Emptying-Prozesses nach Ausführung eines Blutbehandlungsprozesses;

Fig. 17

zeigt schematisch vereinfacht eine erfindungsgemäße externe Funktionseinrichtung in einer weiteren Ausführungsform, betrachtet von ihrer Vorderseite;

Fig. 18

zeigt schematisch vereinfacht ein Detail aus der Darstellung der Fig. 17;

Fig. 19

zeigt schematisch vereinfacht die erfindungsgemäße externe Funktionseinrichtung der weiteren Ausführungsform der Fig. 17, dargestellt in einer perspektivischen Ansicht mit Blick auf ihre Rückseite;

Fig. 20

zeigt schematisch vereinfacht ein Detail der Darstellung der Fig. 19;

Fig. 21

zeigt schematisch vereinfacht die erfindungsgemäße externe Funktionseinrichtung in einer wiederum weiteren Ausführungsform in einer Ansicht von ihrer Vorderseite;

Fig. 22

zeigt schematisch vereinfacht ein Detail aus der Darstellung der Fig. 21;

Fig. 23

zeigt schematisch vereinfacht ein weiteres Detail aus der Darstellung der Fig. 21;

Fig. 24

zeigt schematisch vereinfacht eine erfindungsgemäße Ausführungsform der externen Funktionseinrichtung;

Fig. 25

zeigt schematisch vereinfacht ein Detail aus der Darstellung der Fig. 24; und

Fig. 26

zeigt schematisch vereinfacht ein weiteres Detail aus der Darstellung der Fig. 24.

Hereinafter, the present invention will be described with reference to preferred embodiments thereof with reference to the drawings. In the figures of the drawing, like reference characters designate like or identical elements. The following applies:

Fig. 1

shows a side view of a provided at its front with a cover device according to the invention external functional device according to a preferred embodiment;

Fig. 2

shows the external functional device of Fig. 1 with cover device opened after destructive cutting open;

Fig. 3

shows the external functional device Fig. 1 and Fig. 2 from her backside;

Fig. 4

schematically shows a simplified phase during the performance of a preparation or priming process prior to performing a blood treatment process;

Fig. 5

schematically shows a simplified phase during the execution of a rinsing or rinsing process before performing a blood treatment process;

Fig. 6

schematically shows a simplified phase during the implementation of a first process for connecting a patient to an extracorporeal circuit of a blood treatment device;

Fig. 7

schematically shows a simplified phase during the performance of a second process for connecting or connecting a patient to an extracorporeal circuit of a blood treatment device;

Fig. 8

schematically shows a simplified phase during the performance of a first blood treatment process;

Fig. 9

schematically shows a simplified phase during the implementation of the blood treatment process Fig. 8 using predilution;

Fig. 10

schematically shows a simplified phase during the implementation of the blood treatment process Fig. 8 using post-dilution;

Fig. 11

schematically shows a simplified phase during the implementation of the blood treatment process Fig. 8 using mixed dilution (predilution);

Fig. 12

schematically shows a simplified phase during the implementation of the blood treatment process Fig. 8 using mixed dilution (postdilution);

Fig. 13

schematically shows a simplified phase during the performance of a second blood treatment process using a single-needle access;

Fig. 14

schematically shows a simplified phase during the performance of a first blood recycling process;

Fig. 15

schematically shows a simplified phase during the performance of a second blood recycling process;

Fig. 16

schematically shows a simplified phase during the execution of an emptying or emptying process after execution of a blood treatment process;

Fig. 17

shows schematically simplified an external functional device according to the invention in a further embodiment, viewed from its front side;

Fig. 18

shows schematically simplified a detail from the illustration of Fig. 17 ;

Fig. 19

shows schematically simplified the external functional device according to the invention the further embodiment of the Fig. 17 shown in a perspective view looking at her back;

Fig. 20

shows schematically simplified a detail of the representation of Fig. 19 ;

Fig. 21

shows schematically simplified the external functional device according to the invention in yet another embodiment in a view from its front side;

Fig. 22

shows schematically simplified a detail from the illustration of Fig. 21 ;

Fig. 23

shows schematically simplified another detail from the illustration of Fig. 21 ;

Fig. 24

shows schematically simplified an embodiment of the invention of the external functional device;

Fig. 25

shows schematically simplified a detail from the illustration of Fig. 24 ; and

Fig. 26

shows schematically simplified another detail from the illustration of Fig. 24 ,

For exemplifying the present invention, a blood treatment device is selected as a treatment device and a blood treatment method is selected as a method.

The normal arrows in the figures indicate the direction of the blood flow. The block arrows each indicate the direction of the substituate stream. The double block arrows each indicate the direction of the dialysis fluid flow.

Fig. 1 shows a side view of an external functional device, which at the surface, on the in Fig. 1 is provided with a cover device is provided.

The external functional device is designed here as an example as a cassette 1000.

The cassette 1000 has a hard part 1. As in Fig. 1 shown by way of example, the hard part 1 has chambers, channels and valves. As in Fig. 1 is further exemplified, the chambers, channels and valves are integrated into the hard part 1 or at least partially configured by the hard part 1.
The cassette 1000 of Fig. 1 is at its front with a cover device, here for example a film 3, provided. The covering device can be flat, ie flat, welded onto the hard part 1.

An embodiment with a three-dimensional design of the welding and sealing contour is also possible according to the invention.

The covering device can close off the chambers and / or channels of the hard part 1 of the cassette 1000, namely with respect to a side of the covering device facing away from the hard part 1 and / or with respect to the atmosphere.

As in Fig. 1 can be seen, the film rests on a circumferential sealing ridge 4 on the hard part 1 of the cassette 1000. The film 3 is welded to a circumferential weld 5 with the hard part 1 of the cassette 1000.

The circumferential sealing bar can alternatively be performed exposed.

The film 3 may be connected to the hard part 1 of the cassette 1000 at further local welds (not shown). These may also be circumferential, that is closed in the sense of a final boundary similar to a ring, and / or punctiform.

The film 3 can be connected at local points point or line with the hard part of the cassette 1000, z. B. welded, be, in particular at the edge zones of the liquid-carrying channels.

The film 3 may be laser welded to the hard part of the cassette 1000. It is advantageous if the local heat input takes place using light-absorbing components. The light-absorbing component can be part of the material of the film and / or of the hard part or a layer which is arranged between the film and the hard part or over the film. The layer may be a foil layer.

The cassette 1000 may be at least with the in Fig. 1 shown front to a blood treatment device (in Fig. 1 not shown). An exemplary procedure for the suitable coupling of a cassette 1 to a coupling surface of a blood treatment device is disclosed in the patent applications 10 2009 012 633.3 entitled "Device for Joining an External Functional Device with an Arrangement, Device Having Such Device, and Method of Connection" filed with the DPMA on Mar. 10, 2009; and 10 2009 012 632.5 entitled "Sealing means for sealing a volume of a medical treatment order against another volume as well as disorder and procedure ", which was also filed with the DPMA on March 10, 2009.

The cassette 1000 can be coupled to the plane of the film 3 - or via this - to a coupling surface of the blood treatment device. The coupling surface may preferably be designed in three dimensions.

The coupling surface of the blood treatment device may, for example, at an in Fig. 1 upper section thereof at 8 ° to an in Fig. 1 from top to bottom vertical to the rear (in the Fig. 1 the direction extending from the viewer into the plane of the drawing).

The cassette 1000 has an arterial patient port 7.

The cassette 1000 has an arterial pressure measuring chamber 9. This may have corresponding sensors. The sensors can preferably transmit signals via a cabling. The sensors can also be designed so that they transmit wireless signals.

The cassette 1000 has a connector 11 for the blood outlet from the cassette 1000 and a connector 13 for the blood entry into the cassette 1000.
The two connectors 11 and 13 are connectable to a pump tubing segment or set of a blood pump.

The cassette 1000 also has a chamber 15 with a pressure measuring point for pressure measurement in the extracorporeal blood circulation in front of the dialyzer ("pre-filter") or after the pump ("post-pump").

At the chamber 15, the pressure in the extracorporeal circuit upstream of the dialyzer can be measured through the film 3 or over the film 3.

The cassette 1000 has an arterial filter line 17 and a venous filter line 19.

The interior of the cassette 1000 has a venous blood chamber 21. The venous blood chamber 21 is divided into an upper space 23 and a lower space 25.

The upper space 23 of the venous blood chamber 21 may allow a laterally tangential blood inflow. In doing so, blood can flow laterally through the inlet (the left side in Fig. 1 ) flow into the upper space 23 and propagate tangentially to the walls of the upper space 23. A laterally tangential blood inflow may create a zone of substantially or fully stable rotational flow of the blood in the upper space 23 of the venous blood chamber 21.

The lower space 25 of the venous blood chamber 21 may constitute a calming zone for blood flow. It is possible that there is substantially no or no rotational flow of the blood in such a calming zone.

The venous blood chamber 21 is divided into the upper space 23 and the lower space 25 by a cross-sectional taper 27 of the hard part 1 of the cartridge 1000. The cross-sectional taper 27 reduces the cross-section of the venous blood chamber 21 in its width and depth such that a rapid flow occurs, after the passage of which a fluid flowing through the venous blood chamber 21 of the cassette 1000 assumes a slower flow velocity. The upper space 23 and the lower space 25 are in fluid communication.

By such a construction, ie a division of the venous blood chamber 21 into a zone with substantially or completely stable rotational flow of the blood and into a calming zone for the blood flow, an efficient separation for air from the blood or fluid can advantageously be achieved.

Walls of the upper space 23 and the lower space 25 of the venous blood chamber 21 may suitably incline the upper portion of the cartridge 1000 in FIG Fig. 1 against the vertical, for example, a slope of the upper part of in Fig. 1 cassette 1000 shown by 8 ° backwards (in the drawing plane), adapted. They may be suitably rounded in such a way that they advantageously represent a flow-optimized contact surface for fluids which flow through the venous blood chamber 21.

The cassette 1000 has a clot catcher 29.

As a clot trap, it is preferable to use a clot trap such as that disclosed by the assignee of the present invention in the patent application 10 2009 024 495.6 entitled "Clot Catcher, External Function Facility, Blood Circulation, and Treatment Apparatus" filed with the DPMA on June 10, 2009.

At the clot catcher 29, the pressure in the extracorporeal circuit can be measured through the film 3 or over the film 3, ie in particular after passing through the dialyzer.

The cassette 1000 has a venous patient port 31.
The cassette 1000 has an arterial heparin addition site 33. It should be noted that the heparin addition site 33 (as well as a venous heparin addition site 37) may also be suitable and provided for the addition of pharmacological agents other than heparin, which are only preferably anticoagulants, or drug combinations. This is always to be considered even if heparin is mentioned in any context before or in the following.

The cassette 1000 has a check valve 35 of the arterial heparin addition site 33.

Exemplary check valves for use as a check valve 35 of the arterial heparin addition point 33 and as further check valves of the cassette 1000 are in the patent application 10 2009 024 469.7 by the assignee of the present invention entitled "Valve Device, Valve Core, External Function Device, Treating Device and Method", filed with the DPMA on June 10, 2009.

The cassette 1000 has an arterial heparin adding valve 36. With the aid of the arterial heparin addition valve 36, the addition of heparin into the arterial filter line 17 can be controlled or regulated.

The arterial heparin addition valve 36 may be configured as a so-called phantom valve.

The term "phantom valve", as used herein, refers to an element with an actuator surface achievable by means of an actuator (here, for example, an actuator membrane), which can assume the function of a valve.

The actuator membrane is movable thereon, eg a compressive force, in one direction with the application of a force, expandable or arched or the like. By moving or expanding the actuator membrane, it can attach to or remove from an element, such as a sealing device, such as a web. The actuator membrane can thus effect, for example, a seal or strengthen or terminate or reduce.
When the force is removed from the actuator membrane, it may return to, for example, a home position, eg, a non-domed state.

A phantom valve for use as arterial heparin addition valve 36 and other phantom valves of the cassette 1000 may be configured with or from a land portion of a channel on the hard part 1 of the cassette 1000 and a portion of the film 3 opposite or opposite the land portion.

Phantom valves can be actuated by actuators of the blood treatment device.

To close a phantom valve, the portion of the film 3 can be pressed onto the web portion. To open the phantom valve, the portion of the film 3 can be lifted off the web section again.

Further examples and / or embodiments for phantom valves can be found in the patent application 10 2009 012 632.5 entitled "Sealing Device for Sealing a Volume of a Medical Treatment Device Against Another Volume and Disorder and Procedures" filed on March 10, 2009 by the present Applicant with the DPMA.

The cassette 1000 has a venous heparin delivery site 37. The venous heparin delivery site 37 may be designed as a luer connector.

The cassette 1000 has a check valve 39 of the venous heparin addition site 37.

The cassette 1000 has a venous heparin addition valve 40. With the aid of the venous heparin addition valve 40, the addition of heparin into the venous filter line 19 can be controlled or regulated.

The cassette 1000 has a substituate addition point 41 or a substituate connector.

The substituate addition point 41 may be a connection device as in the patent application 10 2009 024 575.8 of the present applicant, which was filed with the DPMA on June 10, 2009, entitled "Connection Device and Method of Connecting at Least Two Fluid-Delivery Medical Systems, and Medical Device" by the present Applicant.

The substituate addition point 41 may be provided with a touch-proofing member (not shown). The substituate addition point 41 may be provided with a drip guard (not shown). The drip protection can be realized by an integrated sealing sleeve. The drip guard may prevent dripping of remnants of substituate and / or blood upon disengagement of the cartridge 1000 and subsequent removal of the cartridge 1000 from the blood treatment device.

The drip guard can be made removable. It can be configured as a hood or lid.

The substituate addition site 41 or other portion of the cassette 1000 may further provide tamper evidence by which the user can easily or at a glance recognize if the cassette 1000 has already been used. This originality protection can be realized by means of the contact protection element, the closure sleeve or another structure. The corresponding structure may preferably change its position within or relative to the cassette 1000 recognizable. It can preferably change its shape.

In addition, the substituate addition site 41 or other portion of the cassette 1000 may provide reuse protection. Preferably, through a closure sleeve, the cassette 1000 is rendered unusable, preferably irreversibly, with a view to attempting to reuse it. Nevertheless, if the cartridge 1000 is to be reused, sensors of the blood treatment device will not measure the waveforms used when using a new one Cassette would be measured. This may be due to the fact that no liquid can get into the cassette 1000 or into the substituate addition point 41 or at least not in sufficient or usual amount. The control unit of the blood treatment device can recognize this. A warning can be issued.

As tamper-evident or reusable protection, a tamper-evident or reuse protection such as that disclosed by the assignee of the present invention in patent application may be preferably used 10 2009 024 575.8 entitled "Connecting Device and Method of Connecting at Least Two Fluid-Delivery Medical Systems, and Medical Device" filed June 10, 2009 with the DPMA.

The cassette has a connector 43 for a substituate exit from the cassette 1000 and a connector 45 for a Sustituateintritt in the cassette 1000.

The connectors 43 and 45 are connectable to a pump tubing segment or set of a substituate pump.

The cassette 1000 has a substituate addition check valve 47.

Substituate can be introduced into a substituate line 49 via actuation of the check valve 47.

The cassette 1000 has a pre-dilution addition valve 51. The pre-dilution addition valve 51 may be configured as a phantom valve.

The cassette 1000 has a post-dilution addition valve 53. The post-dilution addition valve 53 may be configured as a phantom valve.

The cassette 1000 has a single-needle sterile membrane 55.

The cassette 1000 has a single-needle chamber 57. The single-needle chamber 57 is in Fig. 1 arranged above the venous blood chamber 21.

Inside the single-needle camera 57, a blood surge redirecting element 59 is arranged. The blood surge diverter 59 may serve to decelerate a blood surge and / or cancel its pulse.

A connection to an interior of the single-needle chamber 57 may be provided by means of a connection device as described in the 'Applicant of the present invention entitled ' Device and External Functional Device and Treatment Device for Treating Medical Fluids'. 10 2009 024 467.0 on 10 June 2009 patent application filed with the DPMA.

The cassette 1000 has a single-needle blood valve 61. The single-needle blood valve 61 may be configured as a phantom valve.

The cassette 1000 has a suction 63. The suction 63 can serve for vacuum coupling of the cassette 1000 to the blood treatment device, as for example in the patent application DE 10 2007 042 964 A1 entitled " Apparatus and Method for Treating a Medical Fluid" filed with the DPMA on September 10, 2007.

The cassette 1000 has a primary alignment center 65. The primary alignment center 65 may advantageously serve to align and / or lock the cartridge 1000 to the blood treatment device.

The cassette 1000 has a secondary alignment site 67. The secondary alignment site 67 may serve to align and / or lock the cassette 1000 to the blood treatment device.

The cassette 1000 is filled with gas (e.g., sterile air) prior to priming. When priming the extracorporeal blood circulation, this gas filling must be displaced. A blood treatment cassette is generally a particular challenge, because there are both ascending and descending lines and also chambers in which no "air pockets" may remain. The present cassette 1000 has special design features for this purpose:

The chamber 15 for measuring the arterial pressure is constructed such that all the air into a pump tube segment (eg into the pump tube segment 90, see eg Fig. 4 ) can ascend. There are advantageously no dead spaces. Air, which rises automatically from the arterial pressure measuring chamber into the pump tube segment of the blood pump, is forcibly conveyed from the area of intervention of the blood pump (for example, by the rollers of a roller pump) through the pump tube segment. As soon as the pump has no influence (because, for example, the rollers go into action), the air automatically rises in the conveying direction into the cassette 1000.

The venous return line (or a venous section 93 of the extracorporeal circuit such as in Fig. 4 shown) is a downpipe. From a certain volume flow (eg 200 ml / min at the in Fig. 1 shown cartridge 1000) air bubbles in the blood are also against the gravitational "entrained". This effect is exploited in the downpipes. The pipe cross-sections of the downpipes are designed so small that due to the flow velocity forced transport of the air bubbles also works contrary to the gravitational acceleration.

Large cross-sections are provided in the venous blood chamber 21 in such a way that due to the slow or low flow velocities there, air bubbles can ascend reliably against the main flow direction.

• Die Phantomventile 40, 51 und 53 sind räumlich derart ausgerichtet, dass Blut (welches eine höhere Dichte als Wasser bzw. Substituat etc. hat) bei Betrieb der Kassette 1000 mit Blut kaum "nach oben" oder "zur Seite" in geöffnete Phantomventile eindringen kann, weil es gegenüber dem leichteren Wasser absinkt. Eine solch vorteilhafte Ausrichtung ist durch die Phantomventile 40, 51, und 53 realisiert. Beim Ventil 36 besteht hingegen kein solches Erfordernis, d.h. dort kommt es auf die Orientierung nicht an.

Further design features of the cassette 1000 are:

• The phantom valves 40, 51 and 53 are spatially oriented so that blood (which has a higher density than water or substituate, etc.) can hardly penetrate "up" or "to the side" into opened phantom valves when the cartridge 1000 is operated with blood because it sinks against the lighter water. Such an advantageous orientation is realized by the phantom valves 40, 51, and 53. In the case of valve 36, on the other hand, there is no such requirement, ie, orientation does not matter.

The duct (branch passage) below the substituate check valve 47 is constructed in ascending order for the same reason. In the event of a malfunction of the pre- and / or post-dilution valves 51 and 53 and a resulting blood bypass flow, no blood can ascend into the substituate line 49. Rather, the blood flows past the mouth of the corresponding stub.

The inclination of the cassette 1000 is preferably 5 ° to 11 °, particularly preferably the already mentioned 8 °.

Fig. 2 shows the cassette 1000 of Fig. 1 , wherein the film 3 on the left edge of the cassette 1000 and top and bottom for better illustration cut destructively and can be seen unfolded to the right.

As in Fig. 2 shown, the film 3 has a surface structuring.

Fig. 2 shows the details to be recognized after cutting the film 3 inside the cassette 1000th

To avoid repetition, reference is made to the above in the description of the Fig. 1 referenced embodiments of the individual elements referenced.

It can be clearly seen here that the cassette 1000 has a sealing web 69. The sealing land 69 may be used, for example, for configuring the pre-dilution adding valve 51.

Fig. 3 shows the cassette 1000 from its back. If the cassette 1000 is coupled to the blood treatment device, a viewer will look at this rear side when opening a door of the blood treatment device for removing the cassette 1000.

The cassette 1000 has a single-needle air connector 71. It can be provided to arrange a support grid (not shown) of the single-needle sterile membrane 55 on the single-needle air connector 71 on the device side and / or on the blood side.

The cassette 1000 has a plurality of support webs. The support webs have different heights, related for example to the plane of the film 3, on. The support bars rise in the viewer in Fig. 3 facing side of the cassette 1000, ie from the plane of the Fig. 3 out.

The cassette 1000 has support bars 73 with a height of 5 mm, support bars 75 with a height of 8 mm, support bars 77 with a height of 13 mm, support bars 79 with a height of 24 mm and support bars 81 with a height of 31 mm. Of course, the above and other numerical values are to be understood as purely exemplary.

The support webs may serve to support the cassette in the coupled state to a blood treatment device against a lid of a receiving device of the blood treatment device for receiving the cassette. Exemplary embodiments of such a coupling of the cassette to the blood treatment device are in the patent application 10 2009 012 633.3 entitled "Apparatus for Connecting an External Functional Device to an Arrangement, Arrangement Having Such Device, and Method of Connection", which issued on the 10th. Filed with the DPMA in March 2009.

In Fig. 3 For example, cartridge 1000 is shown as the user / viewer looks at it after docking with the machine interface. The inclination of the cassette 1000 to the machine is "tilted backwards" so that the top edge is farther away from the user / viewer than the bottom edge.

The upwardly facing surfaces of the venous blood chamber 21 and the single-needle chamber 57 accordingly have an inclination such that air bubbles can still reliably rise on the inside despite the inclination of the cassette 1000. In principle, of course, a cassette design is also possible, which does not provide a tilt of the cassette.

The following are based on the Fig. 4 to 16 describe various processes which can be used by means of the external functional device according to the invention in blood treatment.

The blood treatment device has an external functional device, for example, the in the FIGS. 1 to 3 explained cassette 1000 with the above in the FIGS. 1 to 3 described elements on.

The blood treatment apparatus further includes a dialyzer 2000 having a dialyzing fluid inlet 2001 and a dialyzing fluid outlet 2003.

The blood treatment device also has an extracorporeal circuit 3000. The extracorporeal circuit 3000 includes an arterial patient tube clamp 83 and a venous patient tube clamp 85.

The extracorporeal circuit 3000 has a blood pump 87 with a pump tube segment 88.

The extracorporeal circuit 3000 has a substituate pump 89 with a pump tube segment 90.

The blood pump 87 and the substituate pump 89 may be configured as peristaltic pumps, for example roller pumps as in the figures.

The term "conveying direction" or "flow direction" denotes the usual during a blood treatment conveying direction of the blood to be purified from a patient to a dialyzer and the purified blood from the dialyzer in the patient back. This conveying direction runs in the drawing plane of the figure in the counterclockwise direction.

Analogously, the terms "conveying direction" or "flow direction" in connection with the flow of a substituate characterize a conveying direction of the substituate common to a blood treatment from the substituate addition valve 41 into the extracorporeal circuit 3000.

A taking place against this direction of conveyance fluid delivery (in particular blood and substituate) is referred to as promotion or flow in the opposite direction.

The extracorporeal circuit 3000 has an arterial portion 91 and a venous portion 93.

The arterial portion 91 of the extracorporeal circuit 3000 extends from a portion for arterial connection of a patient, for example, an arterial needle, through the cartridge 1000 to a blood inlet at the dialyzer 2000. The arterial portion 91 has various components. Thus, an arterial connection of a patient, the arterial patient port 7, the arterial patient tube clamp 83, the arterial pressure measuring chamber 9, the chamber 15 with arterial post or prefilter pressure measuring point, the pump tube segment 88 of Blood pump 87, the arterial filter line 17 and a blood inlet to the dialyzer 2000 each part of the arterial portion 91 of the extracorporeal circuit 3000th

The venous portion 93 of the extracorporeal circuit 3000 extends from a blood outlet at the dialyzer 2000 to a portion for venously connecting a patient, for example, a venous needle. The venous portion 93 has various components. Thus, a blood outlet from the dialyzer 2000, the venous filter line 19, the venous blood chamber 21, the clot trap 29, the single-needle chamber 57, the venous patient port 31, the venous patient tube clamp 85 and a venous connection of a patient each form part of the venous Section 93 of the extracorporeal circuit 3000.

Fig. 4 FIG. 12 shows a phase during the performance of a priming process for filling the fluid lines used according to a method described herein.

The arterial portion 91 and the venous portion 93 of the extracorporeal circuit 3000 are connected to each other.

The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 of the cassette 1000 are opened. The two patient tube clamps 83 and 85 are also open.

Fig. 4 shows the described configuration as a snapshot or a phase during the preparation or priming process.

Substituate is introduced into the extracorporeal circuit 3000 via the substituate addition point 41. For this purpose, the automatic substituate connector is connected. The arterial patient tube in the arterial section 91 of the extracorporeal circuit 3000 and the venous patient tube in the venous section 93 of the extracorporeal circuit 3000 are connected to a rinse port of the blood treatment device, e.g. Example by means of a suitable connector, with the access to the other patient tube is created for the end of a patient's hose. The end of the other patient tube serves as drainage into the rinse port. The connector may alternatively be in the arterial or venous patient line, ie the arterial section 91 or the venous section 93.

The venous patient tube clamp 85 is closed, the post-dilution addition valve 53 is opened, the pre-dilution addition valve 51 is closed.

The filling of the venous blood chamber 21 takes place by means of the substituate pump 89 through the post-dilution addition valve 53. In this case, an air separation takes place through the single-needle blood valve 61.

The blood pump 87 advances and sucks substituate from the venous blood chamber 21.

When the level in the venous blood chamber 21 decreases, the post-dilution addition valve 53 is fed on until the predetermined fill level has been exceeded by the level detector. During this repetitive process, the blood pump 87 continues to run.

The clot trap 29 is vented "from below": All three cassette valves (51, 53, 61) are closed. The arterial patient tube clamp 83 is open and the venous patient tube clamp 85 is closed. The rinse port is closed.
The blood pump 87 runs backwards briefly and promotes a small volume. As a result, a negative pressure and an arterial overpressure in the extracorporeal circuit 3000 are produced venously.

The venous patient tube clamp 85 is opened until a pressure equalization has taken place.

Subsequently, the filling of the extracorporeal circuit 3000 is continued.

By means of the sensor / detector 115 on the venous patient tube clamp 85, e.g. a venous air bubble detector, the occurrence of air bubbles is detected. As soon as no air bubbles or almost no air bubbles have been detected in the course of a predetermined time interval, the extracorporeal circuit 3000 is considered filled.

Then the filled extracorporeal circuit 3000 is rinsed. During rinsing, substituate is conveyed through the pre-dilution addition valve 51 and discarded by the rinse port ("cock 97").

Both the arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The blood pump 87 runs backwards and conveys some of the substituate into the rinse port.

As an alternative to online filling (the substituate is provided online in the dialysis machine), as already stated above, filling with an external bag containing saline solution is also possible as a source for the filling liquid. For this purpose, the arterial patient line or the arterial section 91 of the extracorporeal circuit 3000 is connected to the bag of saline solution. The venous patient line or the venous section 93 of the extracorporeal circuit 3000 is connected to a so-called waste bag as a sink for the used saline solution. The blood pump 87 is running forward. By opening the pre-dilution adding valve 51 and the post-dilution adding valve 53, the line between these two valves can also be filled.

In both methods, the patient is connected to the extracorporeal circuit 3000 only after reaching a predetermined flushing volume.

Fig. 5 shows a phase of a rinsing process according to a method described herein.

In order to remove the substituate circulating after the preparation or the filling (priming) in the now closed extracorporeal circuit 3000, the stopcock 97 is opened.

The substituate pump 89 is turned on again. The pre-dilution addition valve 51 is opened.

The blood pump 87 and the substituate pump 89 deliver the substituate out of the extracorporeal circuit 3000 via the drain line 95.

Fig. 5 shows the configuration described as a snapshot or in a phase of the rinsing or rinsing process.

The blood pump 87 and the substituate pump 89 constantly deliver new substituate so that the extracorporeal circuit 3000 is purged. The used substituate is discarded.

The blood pump 87 and the substituate pump 89 each feed in a clockwise direction. The blood pump 87 and the substituate pump 89 can promote each other offset. The substituate pump 89 may rotate faster than the blood pump 87.

Fig. 6 FIG. 12 shows a phase of connecting a patient 4000 to the extracorporeal circuit 3000 in a first manner by means of a double-needle access 99 according to a method described herein. Fig. 6 Therefore, in turn - as all figures to process steps - only one phase.

To connect a patient 4000 to the blood treatment device, a double-needle access 99 is used.

The double-needle access 99 has an arterial needle 101 with a fixation 102, e.g. a cuff, plaster and the like, and a venous needle 103 having a fixation 104, e.g. a cuff, a plaster and the like, on.

The arterial needle 101 is connected to the arterial patient port 7 of the cartridge 1000. The venous needle 103 is connected to the venous patient port 31 of the cassette.

The venous needle 103 is placed and fixed to the patient 4000. The arterial needle 101 is placed and fixed to the patient 4000. The venous needle 103 may be connected to the patient 4000 prior to the arterial needle 101.

The extracorporeal circuit 3000 due to its filling is filled with substituate. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

First, both patient tube clamps 83 and 85 are closed.

The blood pump 87 is actuated. The arterial patient tube clamp 83 is opened.

Fig. 6 shows the configuration described as a snapshot with already opened arterial patient tube clamp 83, just before starting the blood pump 87th

The patient 4000 delivers blood via the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000 and displaces or promotes the substituate. The substituate is conveyed out of the blood treatment device via the dialysis fluid outlet 2003 of the dialyzer 2000.

When the blood from the arterial portion 91 of the extracorporeal circuit 3000 arrives at a blood inlet 105 at the dialyzer 2000, the arterial patient tube clamp 83 is closed and the blood pump 87 is stopped.

The venous patient tube clamp 85 is opened.

Via the venous needle 103, blood enters the venous portion 93 of the extracorporeal circuit 3000 in the opposite direction. The blood pump 87 is not actuated.

For example, the blood may enter the venous portion 93 due to gravity.

The blood flows through the venous portion 93 in the opposite direction and enters the clot trap 29 and the venous blood chamber 21. The blood flows through the venous filter line 19 and passes in the opposite direction through the blood outlet 107 in the dialyzer 2000.

Fig. 7 illustrates a phase of a second or alternative process for connecting a patient 4000 to a blood treatment device.

The patient 4000 is connected via an arterial needle 101 and a venous needle 103 to the extracorporeal circuit 3000.

The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

Substituate is present throughout the extracorporeal circuit 3000 (except in the single-needle chamber 57).

The blood pump 87 is started. The dialyzer 2000 is not turned on.

Fig. 7 shows the described configuration as a snapshot. At this time, only substitute in the extracorporeal circulation 3000 is located.

From the patient 4000 blood is conveyed through the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000 while operating the blood pump 87. The blood flows at the blood inlet 105 at the dialyzer 2000 in this and from there through the blood outlet 107 of the dialyzer 2000 in the venous portion 93 of the extracorporeal circuit 3000th

Via the venous filter line 19, the blood enters the cassette 1000 and, with the post-dilution addition valve 53 closed, enters the venous blood chamber 21, the blood being able to flow tangentially into the upper space of the venous blood chamber 21.

From the venous blood chamber 21, the blood returns via the clot catcher 29 from the cassette 1000 via the venous patient connection 103 to the patient 4000.

Fig. 8 shows a phase of dialysis treatment using double-needle access to the patient.

The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

Fig. 8 shows the described configuration as a snapshot during a dialysis treatment while operating the blood pump 87.

The dialyzer 2000 is operated so that dialysis fluid enters the dialyzer 2000 at the dialysis fluid inlet 2001. In the dialysis, the treatment of the patient's blood takes place. The dialysis fluid exits the Dialysierflüssigkeitsaustritt 2003 from the dialyzer 2000. Used dialysis fluid can be discarded or purified.

The blood pump 87 delivers blood from the patient 4000 via the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000, whereby the blood flows through the cassette 1000 and is delivered to the dialyzer 2000.

The blood flows through the dialyzer 2000 in the opposite direction to the dialysis fluid and is thereby cleaned. At the blood outlet 107 of the dialyzer 2000, the purified blood leaves the dialyzer 2000 and flows through the venous filter line 19 into the cassette 1000, enters the venous blood chamber 21 and the clot trap 29 and exits from the cassette 1000 at the venous patient port 31.

Via the venous patient port 103, the purified blood is returned to the patient 4000 again.

There is no supply of substituate. The substituate pump 89 is not operated.

Fig. 9 shows a phase of using Fig. 8 presented blood treatment process using predilution of the blood with substituate ("Online HDF Pre-dilution").

The pre-dilution addition valve 51 is opened. The post-dilution addition valve 53 and the single-needle blood valve 61 are closed. The blood pump 87 is operated. The substituate pump 89 is started. The substituate pump 89 may be operated in unison with the blood pump 87.

The configuration described is as a snapshot in Fig. 9 with substitution between pre-dilution addition valve 51 and post-dilution addition valve 53, and blood flows through the rest of the extracorporeal circuit 3000.

The substituate pump 89 delivers substituate which enters the arterial portion 91 of the extracorporeal circuit 3000 at the pre-dilution addition valve 51 and mixes with the blood to be purified.

Fig. 10 shows a phase of using Fig. 8 illustrated blood treatment process using post-dilution of the blood with substituate ("Online HDF Postdilution").

The post-dilution addition valve 53 is opened. The pre-dilution addition valve 51 and the single-needle blood valve 61 are closed. The blood pump 87 is operated. The substituate pump 89 is started. The substituate pump 89 may be operated in unison with the blood pump 87.

The configuration described is as a snapshot in Fig. 10 with substitution between pre-dilution addition valve 51 and post-dilution addition valve 53, and blood flows through the rest of the extracorporeal circuit 3000.

The substituate pump 89 delivers substituate which enters the venous portion 93 of the extracorporeal circuit 3000 at the post-dilution addition valve 53 and mixes with the purified blood.

Fig. 11 and Fig. 12 show stages of using Fig. 8 illustrated blood treatment process using a mixed dilution of the blood with substituate ("Online HDF Mischdilution - switched"). The term "mixed dilution" refers to a dilution of the blood with substituate taking place alternately from pre-dilution and post-dilution.

Fig. 11 illustrates the predilution interval of the mixed dilution by means of a snapshot, Fig. 12 the postdilution interval of mixed dilution based on a snapshot.

The basis of Fig. 11 Process shown here corresponds to that of the basis of Fig. 9 shown process based on Fig. 12 Process shown to the one Fig. 10 ,

The blood pump 87 and the substituate pump 89 rotate in common mode. For example, the blood pump 87 and the substituate pump 89 may rotate faster than those in the Figs Fig. 9 and 10 illustrated method or method sections.

Fig. 13 shows the cassette 1000 and the extracorporeal circuit 3000 in a phase of a dialysis treatment by means of a single-needle access to the patient ("Cassette Integrated Single Needle").

The patient 4000 has been placed a single-needle access 109 and fixed by means of fixation 110. A fixation 110 may, for example, in turn be designed as a cuff, plaster or the like.

The single-needle access 109 has a Y-piece or a Y-shaped branch 111 in the arterial section 91 and the venous section 93 of the extracorporeal circuit 3000.

The arterial patient tube clamp 83 is opened. The venous patient tube clamp 85 is initially closed. This is in Fig. 13 not shown.

The blood pump 87 is started. The dialyzer 2000 is operated. Blood is delivered from the patient 4000 into the dialyzer 2000 through the arterial section 91. In the dialyzer 2000, the blood is purified. The purified blood is introduced into the venous portion 93 of the extracorporeal circuit 3000.

The blood enters the venous blood chamber 21 of the cassette 1000. The single-needle blood valve 61 is open. Blood enters the single-needle chamber 57.

When the single-needle chamber 57 is nearly full, the blood pump 87 is stopped and the venous patient tube clamp 85 is opened, as in FIG Fig. 13 can be seen. The dialysis process is stopped.

The blood is discharged by gravity from the single-needle chamber 57, the venous blood chamber 21 and the clot catcher 29 from the cassette 1000 and returned to the patient 4000.

When the single-needle chamber 29 is almost depleted of blood, the blood pump 87 is restarted.

This phase of blood treatment is repeated as many times as necessary.

Fig. 14 shows a phase of a first variant of a blood return process after completion of the blood treatment.

The arterial patient tube clamp 83 is opened. The venous patient tube clamp 85 is closed. The substituate pump 89 is operated.

The extracorporeal circuit 3000 contains blood. Substituate is located in the substituate line 49.

The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are initially closed.

The pre-dilution addition valve 51 is opened. Substituate is conveyed through the arterial section 91 of the extracorporeal circuit 3000 in the direction of the dialyzer 2000.

The blood in the extracorporeal circuit 3000 in the conveying direction behind or upstream of the pre-dilution adding valve 51 is conveyed to the patient 4000 through the dialyzer 2000 and the venous section 93.

Shortly before the substituate reaches the venous needle 103, the substituate pump 89 is stopped.

The venous patient tube clamp 85 is opened. The arterial patient tube clamp 83 is closed.

Fig. 14 Fig. 12 shows the configuration of the cassette 1000 in a snapshot during the process in which the substituate is introduced through the opened pre-dilution addition valve 51 upstream into the extracorporeal circuit 3000 and displaces the blood.

The blood pump 87 and the substituate pump 89 are operated. The blood pump 87 rotates clockwise and thus against the conveying direction. The substituate pump rotates counterclockwise. The blood pump 87 and the substituate pump 89 can rotate offset from each other.

The substituate is delivered from the post-dilution addition valve 53 into the arterial portion 91 of the extracorporeal circuit 3000 and through the pump tubing segment 88 of the blood pump 87 toward the patient 4000. The substituate displaces the blood in the arterial portion 91 between the arterial needle 101 and the pre-dilution adding valve 51.

Shortly before the substituate reaches the arterial needle 101, the blood pump 87 and the substituate pump 89 are stopped.

Fig. 15 illustrates a phase of an alternative blood recycling process. A sensor / detector 113 or a sensor / detector 115 for measuring the optical density of the line interior of the extracorporeal circuit 3000 and for automatically detecting the occurrence of substituate are respectively provided on the arterial patient tube clamp 83 and the venous patient tube clamp 85. Other and / or further suitable sensors can be used. Sensor and detector can be realized as a one-component component or as separate components.

The fixation 102 of the arterial needle 101 is released and the arterial needle 101 is pulled. The arterial patient tube clamp 83 is opened. The pre-dilution addition valve 51 is closed.

The venous needle 103 remains connected to the patient 4000. The venous patient tube clamp 85 is closed.

The blood pump 87 is operated in the conveying direction and delivers blood from the arterial portion 91 of the extracorporeal circuit 3000.

A corresponding snapshot of the process showing a state shortly after the process starts is in Fig. 15 shown.

The sensor / detector 113 detects the occurrence of substituate. The blood is further delivered until it reaches the pre-dilution addition valve 51. Then the blood pump 87 is stopped.

The substituate pump 89 is started. The arterial patient tube clamp 83 is closed. The venous patient tube clamp 85 is opened.

The pre-dilution addition valve 51 is opened. The substituate pump 89 delivers the substituate through the arterial portion 91 of the extracorporeal circuit 3000, through the dialyzer 2000 and the venous portion 93 of the extracorporeal circuit 3000 until the sensor / detector 115 on the venous patient tube clamp 85 detects the appearance of substituate.

The blood is returned to the patient 4000 through the venous needle 103.

Fig. 16 shows the cassette 1000 and the extracorporeal circuit 3000 in one phase of an emptying or emptying process.

The patient is no longer connected to the treatment device. The arterial portion 91 and the venous portion 93 of the extracorporeal circuit 3000 are connected to each other.
The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51 and the post-dilution addition valve 53 are opened as shown in FIG Fig. 16 is illustrated in the form of a snapshot.

Air is introduced into the extracorporeal circuit 3000 through the substituate addition point 41 while operating the substituate pump 89. The air flows through the opened pre-dilution addition valve 51 and the opened post-dilution addition valve 53 and thus enters the extracorporeal circuit 3000.

The air flows through the extracorporeal circuit 3000 and the dialyzer 2000 in the opposite direction.

The pre-dilution addition valve 51 is closed and the blood pump 87 is operated. The blood pump 87 and the substituate pump 89 convey the air in the conveying direction through the cassette 1000 into the dialyzer 2000. The air exits the dialysis fluid outlet 2003.

Further suitable methods for returning the blood to a patient and / or for emptying the extracorporeal circuit are, for example, in the patent application 10 2009 008 346 .4 10 2009 008 346.4 entitled "Method for Removing Blood from an Extracorporeal Blood Circulation for a Treatment Device After Completing a Blood Treatment Session and Apparatus for Performing the Same" , filed with the DPMA on February 11, 2009.

Such methods are further in the patent application of the present applicant 10 2009 024 606.1 entitled " Procedure for removing blood from a extracorporeal blood circulation, treatment device, and tubing system ", filed with the DPMA on June 10, 2009.

Fig. 17 shows schematically simplified an inventive external functional device 1000 in a further embodiment, viewed from its front. The cassette 1000 corresponds to the Fig. 17 as well as of all following figures in the predominant number of their features the in the FIGS. 1 to 16 illustrated embodiment of the cassette 1000th

In the Fig. 17 shown embodiment of the cassette 1000 has a handle 117 for - advantageously simple and / or rapid - upgrading and / or disassembling the cartridge 1000 before or after the completion of the blood treatment. The handle 117 may also be useful in a disassembly, which generally requires a greater amount of force.

The handle may be configured to be operated by a tool, not primarily or exclusively by hand.

Furthermore, the in Fig. 17 shown embodiment of the cassette 1000 a tapping point 119. The tapping point 119 of the cassette 1000 may be provided for withdrawing substituate from the cassette 1000.

The tap 119 can in addition to all in the Fig. 1 to 16 be provided structures and lines.

The tapping point 119 may be provided so as not to be traversed by fluid in the normal blood treatment operation of the cassette 1000. Preferably, in this case, during the treatment, no fluid leaves the cassette 1000 through the tap 119 or enters the cassette 1000 through the tap.

According to the invention, the tapping point 119 can also be provided at a location other than the position shown in the figures.

The tapping point 119 may according to the invention, for example, in exceptional cases as a body for removing a fluid such. B. Substituate serve. The withdrawn fluid, e.g. Substituate, can be used as a displacement fluid in a, possibly manual, return or arterial infusion of extracorporeal blood into the vascular system of the patient by means of the arterial line. The latter can be useful in the case of blockage of certain lines or in the event of failure of cassette functions or functions of the treatment device, in that a suitable fluid for the purpose of recycling can be obtained via the tapping point without any special effort.

The tap 119 may be provided on the cassette 1000 in various ways and connected thereto. In certain embodiments of the invention, the tapping point is made integral with the housing body of the cassette 1000. The tapping point may be or have a Luer lock molded onto the cassette.

In some embodiments according to the invention, the tapping point has a valve, in particular a switchable valve.

In certain embodiments of the invention, the tapping point is also suitable and provided for adding a fluid to the substituate.

The external functional device 1000 of the Fig. 17 further includes tube fixings 121 and 123. The hose fixtures 121, 123, which may be provided in any other number, may advantageously prevent in certain embodiments that the hoses required in use of the cassette 1000 in the handling of the cassette 1000 may be disturbed or damaged, for example by the coupling of the Hang the cassette 1000 eg in the opening of a door of the treatment device.

The reference numeral 125 denotes a check valve, which is designed, for example, as in the patent application 10 2009 024 469.7 by the assignee of the present invention entitled " Valve Device, Valve Core, External Function Device, Processor Apparatus and Method " filed June 10, 2009 with the DPMA.

The check valve 125 may be a venous line delivery valve.

Fig. 17 further discloses a heparin delivery site 127. This is in the embodiment of the Fig. 17 in an upper region of the cassette 1000 above the single-needle chamber 57 and above the venous blood chamber 21.

The heparin access site 127 is in fluid communication with a heparin delivery line, in short, heparin line 128. In the embodiment of FIG Fig. 17 from the heparin access point 127 down to a height of the cassette 1000 in which the venous blood chamber 21 begins.

Good to see in Fig. 17 Furthermore, that the cassette 1000 in a lower edge region U, for example in the vicinity of the clot catcher 29 or even below, comparatively few structures which perform functions has. Thus, space has been created or left on the cassette 1000 in the peripheral area U to allow the coupling of the cassette 1000 with measuring devices or the like, which are for example connected to the treatment device, a door thereof or other facilities. Such measuring devices may be arterial and / or venous temperature sensors, air bubble detectors, sensors for measuring optical density, and the like.

The provision of space required for this purpose with the associated possibility to prove this with the above-mentioned and other sensors, thus serves the process reliability and thus the exclusion of risks for the patient.

It is obvious that the region U may also be provided in another region of the cassette 1000. Likewise, more than one such area may be provided. Particularly preferably, such areas are provided in an edge region of the cassette 1000 and / or at or in the vicinity of incoming or outgoing lines. Due to such favorable locations of possible sensors, the area also serves, directly or indirectly, to increase accessibility, improve ergonomics, and reduce costs, e.g. for the connection of the aforementioned sensors with evaluation units (short signal lines).

Fig. 18 shows schematically simplified an enlarged view of a region A of Fig. 17 , This in Fig. 18 For example, a check valve 125 shown enlarged can be integrated into the cassette 1000 as a valve for the postdilution addition of substituate in such a way that it can be flushed with substitituate after the treatment has ended. In this way, it can advantageously be possible for cavities to be able to be vented more effectively in the area of the check valve when priming and rinsing the cassette 1000. It may advantageously be possible for this arrangement after emptying of the cassette 1000 after completion of the blood treatment to leave no or no visible blood residues. In this way, it may also be possible to contribute to a reduction of the risk of contamination of third parties in disposing of the cassette 1000 after use by remaining blood therein. The check valve 125 is preferably arranged so as to be washed around in the usual use of the cassette 1000 without human intervention.

Fig. 18 further shows a phantom valve 129 and a phantom valve 130. Phantom valves are described in detail elsewhere in this application. For details, see these points.

Fig. 19 schematically shows in simplified form the external functional device according to the invention of the further embodiment, shown in a slightly perspective view with a view substantially to its rear side.

In addition to the structures already discussed above with respect to other figures, the in Fig. 19 In addition, the cartridge 1000 shown in FIG. 1 also has an attachment point 131 having a septum. The addition point 131 with septum (also called Septumzugabestelle shortly) is in the in Fig. 19 shown embodiment disposed at the level of the upper edge of the cassette 1000. The upper edge of the Fig. 19 corresponds to an example of an upper portion of the cartridge 1000.

Fig. 20 shows schematically simplified the area B of the representation of Fig. 19 in magnification.

Fig. 21 shows schematically simplified, the external functional device according to the invention in yet another Ausführungsfonn in a slightly perspective view, essentially from its front.

In this again further embodiment, the cassette 1000, unlike in the embodiment, for example, the Fig. 17 no tapping point (marked there with reference numeral 119) on.

Fig. 22 shows schematically simplified the area A of the representation of Fig. 21 in magnification. Good to see is an arrangement of the phantom valve, which differs from the arrangement in Fig. 18 different. The different arrangement can lead to different Umspülbarkeit.

Fig. 23 shows schematically simplified further details, namely the area B, the representation of Fig. 21 ,

As in Fig. 23 As can be seen, the venous blood chamber 21 has a recess 133 or constriction or inclination change or rejuvenation or asymmetry of the inner and / or outer wall of the venous blood chamber 21. The indentation 133 is in Fig. 21 and Fig. 23 to be recognized in each case on the right edge and the front of the venous blood chamber 21.

The indentation 133 may be located at least on the side opposite the inflow line.

The indentation 133 may relate to a portion of the circumference or the entire circumference of the hard part of the venous chamber.

The indentation 133 may be substantially horizontal in a position of use of the cartridge 1000.

The indentation 133 may in certain embodiments correspond to or include a change in the circumference and / or diameter of a portion of the venous blood chamber 21 or the wall thereof.

The indentation 133, in some embodiments according to the invention, may have a non-semicircular diameter of the venous blood chamber 21 (at the level of the indentation 133) in a horizontal section (referring to the illustration of the cassette 1000 in FIG Fig. 21 or an arrangement of the cassette 1000 in use) or include this.

The indentation 133 may, in certain embodiments according to the invention, be a taper of the chamber cross-section, in particular in the up-down direction of the representation of FIG Fig. 21 ,

The indentation 133, in some embodiments according to the invention, may be a section or transition region in or by means of which a larger cross section or a larger cross sectional area of the venous blood chamber 21 merges into a smaller cross section or a smaller cross sectional area of the venous blood chamber 21, in particular in the top and bottom Direction of the representation of Fig. 21 ,

The indentation 133, in certain embodiments of the invention, may be a dent, which extends over a portion of the circumference of the venous blood chamber 21, particularly in the up-down direction of the illustration of FIG Fig. 21 ,

The indentation 133 may, in certain embodiments, be shaped into an asymmetrical shape of the venous blood chamber 21 as shown in FIG Fig. 21 lead in up-down direction.

The indentation 133, which can run partially or completely over the entire cross section of the venous blood chamber 21, has surprisingly led to a reduced foaming within the venous blood chamber 21.

In the optimization of the geometry of the venous blood chamber 21 achieved by means of the indentation 133, with which optionally the geometry of a single-needle valve may also have been optimized, in certain embodiments according to the invention an improved venting can be achieved before the beginning of the treatment. Further, in some embodiments of the invention, improved steam flow during sterilization can be achieved. In addition, in certain embodiments of the invention, a reduction of dead water areas can be achieved with the known advantages associated therewith.

Fig. 24 schematically shows the simplified external functional device according to the invention as a cassette 1000 in a perspective obliquely from below and from the front.

Fig. 25 shows schematically simplified the area C of the representation of Fig. 24 in magnification. It can be seen that a valve seat 135 of the single-needle (SN) valve is lowered relative to the environment or adjacent lands or parts of the housing body of the cassette 1000. As a result, the inventors were able to achieve fluidic advantages which can not least be associated with avoiding or reducing the formation of turbulence. The lowering can be eg 0.5 mm.

Fig. 26 shows schematically simplified the area D of the representation of Fig. 24 in magnification. Fig. 26 It can be seen that valve seats 137 and 139 are lowered by phantom valves with respect to the environment or adjacent webs or parts of the housing body of the cassette 1000. The lowering can be eg 0.5 mm.

Claims (19)

1. An external functional means, comprising:

   at least one housing body,

   at least one chamber (9, 15, 21, 57) integrated into the housing body for receiving medical fluids;

   at least one passage (17, 19, 49) integrated into the housing body for receiving and/or conducting a medical fluid; and

   at least one valve means (35, 36, 39, 40, 47, 51, 53, 61) completely or partly integrated into the housing body for controlling or regulating a fluid flowing through the external functional means,

   wherein the external functional means is provided on at least one of its surfaces with a cover means that is part of at least one integrated valve means (35, 36, 39, 40, 47, 51, 53, 61), and

   wherein the cover means is connected by frictional and/or by form closure and/or by material connection to the housing body in at least one portion thereof,

   wherein the external functional means is configured as a cassette (1000) for a blood treatment, and

   wherein the external functional means comprises at least one venous blood chamber (21),

   wherein the at least one valve means comprises a single-needle blood valve (61) arranged between the venous blood chamber (21) and a single-needle chamber (57) of the external functional means which is arranged above the venous blood chamber (21) with regard to the alignement of the external functional means during a state of use of the external functional means.
2. The external functional means according to claim 1, wherein the cover means is connected to the housing body by means of at least one peripheral weld (5).
3. The external functional means according to claim 1 or 2, wherein the cover means is connected to the housing body by means of additional, non-peripheral or dot-shaped or local welds.
4. The external functional means according to any one of claims 1 to 3 wherein the cover means is connected at at two sides or bilaterally with at least one structure of the external functional means.
5. The external functional means according to any one of claims 1 to 4, wherein the cover means is a film (3).
6. The external functional means according to any one of the preceding claims, which comprises connections for being connected in fluid communication to an extracorporeal circuit, and which is additionally comprising at least one addition site (131) comprising at least one septum suited and provided for supplying a fluid which is not or not exclusively blood, into an interior or into a line section of the external functional means.
7. The external functional means according to any one of the preceding claims comprising:

   a supplying line which is completely or partly arranged in an upper area or in a border area of the external functional means with respect to the alignment of the external functional means during its use, and

   at least one heparin line (128) arranged at least in an area of the external functional means which is arranged in an upper area thereof during the use of the external functional means.
8. The external functional means according to any one of the preceding claims comprising at least one handle bar or handhold (117) for connecting and/or separating the external functional means with or from a treatment apparatus.
9. The external functional means according to claim 1, which comprises, in a portion of an extracorporeal circuit (3000) contained therein, at least one arterial cassette-integrated chamber and at least one venous cassette-integrated chamber,
   wherein the cassette (1000) comprises at least one cover means as a film (3), and wherein an arterial and/or a venous pressure present in the extracorporeal blood circuit may be measured through the intermediary of the film (3), and
   wherein the external functional means comprises a means for measuring the arterial and/or venous pressure above the arterial and/or venous chamber through the intermediary of the film (3).
10. The external functional means according to any one of the preceding claims comprising two connectors (11, 13, 43, 45) adapted to be connected in fluid communication with at least one peristaltic pump, and wherein the external functional means comprises or is configured for receiving at least one pump tube segment (88, 90).
11. The external functional means according to any one of the preceding claims, comprising:

    at least one valve means (36, 40, 51, 53, 61), which comprises at least one bar formed on the housing body and at least one portion of the cover means,

    wherein bar and cover means are disposed so as to be operable by means of an actor of a blood treatment apparatus acting on a bar by means of the cover means in order to alter a flow of fluid.
12. The external functional means according to any one of the preceding claims, which is intended and adapted to be coupleable to a blood treatment apparatus by means of a reception means of the blood treatment apparatus with a surface facing the cover means.
13. The external functional means according to any one of the preceding claims, comprising at least one substituate addition site (41) having a touch-protection element and/or a drip-protection element.
14. The external functional means according to claim 1, wherein the venous blood chamber (21) is subdivided into at least one upper space (23) and at least one lower space (25) by means of a cross-sectional restriction (27) of the housing body.
15. The external functional means according to claim 14, wherein the upper space (23) and the lower space (25) are in fluid communication or in fluid connection with each other, and
    the upper space (23) is configured for admitting or generating a tangential inflow of fluids flowing through the external functional means, wherein the upper space (23) includes a region for generating a stable rotational flow of the fluids flowing through the external functional means, and
    wherein the lower space (25) includes a region that is substantially or entirely free from rotational flow of the fluids flowing through the external functional means.
16. The external functional means according to any one of the preceding claims, comprising a tamper protection.
17. The external functional means according to any one of the preceding claims, comprising a protection against reuse.
18. System with a blood treatment apparatus and at least one external functional means according to any one of claims 1 to 17, wherein the blood treatment apparatus comprises at least one control means, actors and/or sensors for driving and/or operating the external functional means, and a reception means for receiving the external functional means, wherein the reception means comprises a coupling surface for coupling the external functional means.
19. System according to claim 18 wherein the blood treatment apparatus is designed as a dialysis apparatus.

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